HomeMy WebLinkAboutWell New 1009 Foster Street Extension ` a
CPR-8 Rev.7/95 PERMIT NUMBER
STATE OF CONNECTICUT 211140
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE&PROFESSIONAL TRADES DIVISION
WELL DRILLING PERMIT
165 Capitol Avenue,Hartford,Connecticut 06106
LOCATION OF WELL (Town) (sr-0 (L&Number) DATE
S.WINDSOR 1009 FOSTER ST.EXT. 2/8/02
OWNER OF WELL
® INDIVIDUAL BUILDER OTHER(Specify)
OWNER'S ADDRESS
Est No.of
PROPOSED ® DOMESTIC BUSINESS FARM TEST People being
USE OF ESTABLISHMENT WELL served.
WELL
SUP PUBLIC
Y (Specify)
AIR mER4
INDUSTRIAL CONDITIONING
SKETCH OF WELL LOCATION
Locate well with respect to at least two roads,showing distance from intersection and front of lot
location of lot to at least two roads Well location on to and to house(if present)
0
Indicate North f 7�
pt1;, LL
Approximate number of feet from well to
nearest source of possible contamination: ABANDONMENT
The undersigned is aware that upon completion of the well, a'Well Completion Report"containing construction details and information required under
Section 25-131 of the 1969 Supplement to the General Statutes must be sent to the owner, the Department of Consumer Protection and the Water
Resources Commission on the form provided by the agency. This permit is not valid until all information is filled.in and it has been counter-signed by
the Director of Health or his agent.
APPLICANTS ADDRESS REGISTRATION NO.
P.O. BOX 406, WILLAINGTON, CT. 42 `
BY(Town Health Ofter or Agent) DATE
PROVED ❑ REJECTED �Y ? 2
/ O
REMARKS
RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION
w r
CPR-9 Rev.7/95 DO NOT fill in
STATE OF CONNECTICUT STATE WELL NO.
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE&PROFESSIONAL TRADES DIVISION OTHER NO.
WELL-DRILLING COMPLETION REPORT
165 Capitol Avenue,Hartford,Connecticut.06106-
OWNER �E DRESS
AD
PAGANELLI CONST. P.O. BOX 652, 8ggN S9-R SUS Z j
LOCATION • (Na d Street) (Town) I (Lot Number)
OF WELL 1009 FOSTER ST.EXT. 57.WTQ5SA8
. -- . - --5Ag*0'-
DOMESTIC BUSINESS FARM TEST
PROPOSED ESTABLISHMENT WELL
USE OF WELL a PUBLIC ❑ INDUSTRIAL a AIR L OTHER
SUPPLY CONDITION I�.J s ABAMNDONMENT .
DRILLING ROTARY COMPRESSED• CABLE OTHER
EQUIPMENT 0 'AIR PERCUSSION PERCUSSION (Specify)
CASING LENGTH(feel) DIAMETER(indm) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS THREADED El WELDED
YES ' ❑ NO. 1 .13 YES ONO
YIELD TEST' Q BALLED PUMPED a COMPRESSED AIR HOURS YIELD(GPM)
WATER MEASURE FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TEST(feel) Depth of Completed Well in feet
LEVEL- ZX7{ -2.5
MAC LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(bidiesj IF GRAVEL Diameter of well GRAVEL SIZE(indves) FROM(feet) TO(feel)
PACKED: -dudxV gravel pads
(ir�chen) .
DEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION Sketch exact bcation of well with distances,to at least two
FEET TO FEET. permanent landmarks
0 75 IN CEMENTED
• J H
If yield was tested at different depths during drilling,list below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED T PERMIT NO. REGISTRATION NO. DATE OF REPORT WELL 0 LLER(Signature)
9BX 2/10/0 211140 42 - 5/20/02
AGENCY